| Objective:Comparative analysis of cervical cancer screening results of 16408 rural women in Gujiao by different test methods.Methods:During the period of 2015-2017,16408 rural women(married,35-64 years old)in the 14 downtowns of Gujiao,Shanxi Province,voluntarily accepted for cervical cancer screening by experienced doctors.Human papillomavirus(HPV)test,Pap smear test,Thinprep Cytology Test(TCT)and cervical exfoliated cell DNA ploidy test were used respectively.The Bethesda system(TBS)classification was used in judging the results of Pap smear test and TCT,and it’s positive rusult is atypical squamous cells of undetermined significance(ASC-US)and above,and/or cervical gland cell abnormalities.Positive result of cervical exfoliated cell DNA ploidy test is ≥3 aneuploid cells.Wmen,who were with cytologic positive,or HPV16/18 positive,or other HPV type positive(except 16/18 type)with abnormal TCT results,would be undergone colposcopy.Under the colposcopy,cervical tissue was taken for pathological examination in the suspicious cervical lesions and the 3,6,9 and 12 point cervical tissues were taken for pathological examination in no-abnormal cervix.Endocervical curettage(ECC)would be used in women with incomplete colposcopy.Results:1.The average age of the 16408 women screened was 47.69±7.65 years old(range from 35 to 64).Different test methods were used to consistently distribute the populations of different age groups and education levels.Among the women who participated in the screening,31.51% were 35-44 years old,38.75% were 45-54 years old,29.74% were 55-64 years old.About highest education level,46.77% women were primary school and below,25.41% were junior school.14.90% were high or technical secondary school,13.03% were junior college or above.The level of education in women groups has significant difference(P<0.05).2.5616 cases were tested by Pap smear judged by 2001 version of TBS cytology classification.5480 cases(98.33%)were negative for intraepithelial ledion or malignancy(NILM);94 cases(1.67%)were positive,including 40 cases(0.71%)for ASC-US,2 case(0.04%)for atypical glandular cells(AGC),4 cases(0.07%)for atypical squamous cell,cannot exclude high-grade squamous intraepithelial lesion(ASC-H),26cases(0.46%)for low-grade squamous intraepithelial lesion(LSIL),21 cases(0.37%)for high-grade squamous intraepithelial lesion(HSIL),1 case(0.02%)for squamous cell carcinoma(SCC).3.2347 cases were tested by TCT judged by 2001 version of TBS cytology classification.2272 cases(96.80%)were NILM;75 cases(3.20%)were positive,including 33 cases(1.19%)for ASC-US,1 case(0.04%)for AGC,4 cases(0.17%)for ASC-H,30 cases(1.28%)for LSIL,6 cases(0.26%)for HSIL,1 case(0.04%)for SCC.4.Among the 6845 cases who were tested by DNA ploidy,positive cases were 278,and the positive rate was 4.06%.5.Among the 1600 cases,191 cases were positive with HPV types,the rate of positive was 11.94%;48 cases were 16/18 types(+),the positive rate was 3.00%;143cases were positive with other HPV types(except 16/18),including 120 cases(7.50%)for normal TCT test results and 23 cases(1.44%)for abnormal TCT test results;1409cases were negative with HPV types(88.06%).6.The positive rate of ASC-US and above and abnormal glandular cells tested by Pap smear method was 1.67%,and the positive rate of TCT was 3.20%,which was higher than Pap smear test.The difference was statistically significant(P<0.001).The positive rate of DNA ploidy test was 4.40%,which was slightly lower than the positive rate of HPV test of 4.44%.The difference was not statistically significant.The positive rates of DNA ploidy and HPV test were higher than Pap smear test and TCT,and the differences were statistically significant(P<0.05).7.Histopathological results showed that among the 16408 women,130 cases with CIN2+ were detected,and the detection rate was 0.79%.Among them,26 cases were tested by Pap smear,and the rate was 0.46%(26/5616).18 cases were tested by TCT,and the rate was 0.77%(18/2347).63 cases were tested by DNA ploidy,and the rate was0.92%(63/6845),23 cases were tested by HPV,and the rate was 1.44%(23/1600).In the pairwise comparison,there was significan difference between the DNA ploidy and the Pap smear test(P=0.003);there was significan difference between the HPV and the Pap smear test(P<0.001);and there was no difference between the DNA ploidy and the HPV test(P>0.05).The positive predictive values from high to low were: DNA ploidy test >Pap smear test > TCT > HPV test.Conclusion:1.The positive screening rates and CIN2+ detection rates of HPV test and DNA ploidy test were higher than Pap smear test and TCT.2.Pap smear method maybe still has its value in remote areas with underdeveloped economic conditions;HPV test could be used as a screening method for cervical cancer in areas with certain economic conditions. |
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